Abstract
Perforation of the interventricular septum following acute myocardial infarction is considered to be an extremely rare complication. This disease was first recorded by Latham (1845), and Brunn (1923) made the first ante-mortem diagnosis. Later Zucker, Oblath, Bond, Reiff, and Sanders published papers concerning the disease. Thus, a considerable number of reports have so far been made public in the Western countries, where this complication is fairly well known. However, in Japan, where cases of myocardial infarction are relatively few, this particular complication likewise is a rather rare occurrence, and only three cases have so far been reported by Ishii, Kitamoto and Murao. Of them, Murao alone has reported on a case with an ante-mortem diagnosis.The present author and his collaborators have recently made an ante-mortem diagnosis of perforation of the interventricular septum following acute myocardial infarction, which was confirmed with autopsy, about which a report is herewith submitted. Also a review of the domestic foreign literature has been made.(Case Report) 57 years of age, male, occupation;medical doctor Past history : The patient had been healthy and had not suffered from severe disease. While working as the director of a certain army hospital during the World War II, he had several anginal attacks per year. Each attack, however, subsided after brief rest, causing no adverse effect on his discharge of daily duties. After the war, he worked at a clinic. He was kept busy, and especially when he was tired, he would often complain of palpitation, dyspnea and slight dizziness. Each of these complaints, however, subsided after brief rest, and he himself was under the impression that he was suffering probably from neurocirculatory asthenia.Since about ten years ago, he was conscious that he had hypertension (160/110 mmHg), but no treatment of the hypertension was done. Cardiac murmurs had never been noted before the present hospitalization.Present illness : On June 2, 1958, he suddenly complained of retrosternal pain and epigastric pain, accompanied with chills, fever, vomitting and dyspnea. The pain irradiated over the right back, right shoulder and right arm, and especially the right arm became numb. With injections of morphine, the pain could not be abated. He suffered from the pain for three consecutive days.On June 8, his condition slightly improved and he left bed. On June 9, as he took breakfast, a violent retrosternal and epigastric pain re-curred. This attack was severe than the previous one, and refused to subside even with the administration of narcotics. It was followed by sweating, difficulty in respiration and cyanosis. He was immediately hospitalized in the Department of Internal Medicine of this hospital Findings at the time of hospitalization : The skin was dry and subjaundiced. Temperature stood at 39°C. Puls was 132, fine and regular, and tension was extremely unsatisfactory. Blood pressure was 90/85 mmHg. The patient appeared to be in agony with orthopnea.Cardiac dullness was enlarged 1 f. b. to the left and right. In auscultation, a harsh grade IV systolic murmur, resembling a maladie de Roger's murmur, with systolic thrill was heard, loudest at the third and fourth intercostal space to the left of the sternum. The murmur radiated to the apex and the basis of the heart. From the third intercostal space at the left parasternal line to the apex, a grade II diastolic murmur was heard at one time. The lungs were clear. The liver and spleen were not palpable.The laboratory findings, as shown in Table I, included neutrophilic leucocytosis, markedly increased sedimentation rate and increase of non protein nitrogen. In the electrocardiogram, a typical antero-septal infarction was indicated. (Fig. 1).In the light of these findings, acute myocardial infarction, and perforation of the interventricular septum following it, were diagnosed. [the rest omitted]
